ANIMAL SHELTER - INTAKE FORM

DATE:_____________

SHELTER NAME:_____________________________________________ TOWN:__________________

SHELTER CONTACT:_________________________________________ PHONE:_________________

STRAY:____ OWNER TURN-IN: ____ AGE:_____ SEX:____ ALTERED: ____ COLOR:_________

OWNER TURN IN

DATE:__________

AKC PAPERS: ____________________________________________ AKC#______________________

HOUSEBROKEN:_______ BARKER:_______ GOOD WITH CHILDREN: Y/N AGES:_____________

DOG AGGRESSIVE: ____ DIGGER: ____ GOOD WITH OTHER ANIMALS_____________________

DOGS NAME: _______________________ REASON FOR TURN IN:____________________________

SHOT RECORD:________________________________________________________________________

VWD CHECK: _______________ VETERINARIAN: _________________________________________

OTHER COMMENTS. __________________________________________________________________

____________________________________________________________________________________

_____________________________________________________________________________________

STRAY

LOCATION FOUND:_____________________________________________ I.D.TAGS:_____________

CONDITION OF DOG:__________________________________________________________________

OTHER COMMENTS:___________________________________________________________________

____________________________________________________________________________________

COSTS

SHELTER RELEASE: ____________ SHOTS: __________ SPAY/NEUTER: _____________

OTHER MEDICAL: _________________ OTHER: _______________________________________

TOTAL COST:_________________________________________________________________________

DISPOSITION OF DOG: ________________________________________________________________

___________________________________________________________________________________

RESCUE AGENT: _____________________________________________________________________